Akifumi Izumihara

Postoperative Outcome of 37 Patients With Lobar Intracerebral Hemorrhage Related to Cerebral Amyloid Angiopathy

BACKGROUND AND PURPOSE Several recent studies have suggested that neurosurgical procedures are not contraindicated in patients with cerebral amyloid angiopathy (CAA). The purpose of this study was to elucidate the clinical factors influencing the outcome of patients with CAA-related intracerebral hemorrhage (ICH) treated surgically. METHODS A total of 50 neurosurgical procedures (42 intracerebral hematoma evacuations, 4 ventriculoperitoneal shunts, 3 ventricular drainages, and 1 brain biopsy) were performed in 37 patients with CAA-related ICH. To ascertain the clinical factors that may influence their postoperative outcome, their clinical data (demographics, medical history, recurrent lobar hemorrhage, radiographic characteristics, multiple lobar hemorrhage, surgical details, and postoperative hemorrhage) were examined retrospectively and subjected to multivariate analysis. RESULTS Twenty patients (54%) had a good outcome, and only 4 (11%) died. Parietal hematomas, advanced age (>/=75 years), and intraventricular hemorrhages had significant adverse influence on the postoperative outcome. Clinically significant postoperative hemorrhage requiring evacuation occurred after 2 (5%) of 42 intracerebral hematoma evacuations. Postoperative hemorrhage did not have significant adverse influence on the outcome. CONCLUSIONS Neurosurgery can be performed relatively safely in patients with CAA-related ICH, and their postoperative outcome is better than that reported previously. Surgical treatment should be considered for such patients aged <75 years without a parietal hematoma and intraventricular hemorrhage.

Early, evolving Wallerian degeneration of the pyramidal tract in cerebrovascular diseases: MR study.

Objective The purpose of this study was to demonstrate the early features of the Wallerian degenerative process and their relationship with the severity of motor deficit. Materials and Methods Fourteen patients with infarction or hemorrhage of the basal ganglia were studied by MRI of the same coronal slice along the pyramidal line. Results The earliest sign of abnormal signal intensity was detected 0.7 month after the initial insult. On proton-density (PD) imaging, low signal intensity was observed on 11 (73.3%) of 15 occasions from 0.7 to 2.0 months, and abnormal signal intensity was not detected 5 (83.3%) of 6 times from 2.1 to 3.7 months. High signal intensity was revealed on 11 (78.6%) of 14 occasions after 3.8 months. The widest extent of the low-intensity signal band on PD imaging was closely related to the severity of motor deficits at >4 months. Conclusion The development of the Wallerian degenerative process was divided into four stages by MRI. We conclude that the extent of Wallerian degeneration is related to the severity of motor deficit.

Transient hydrocephalus due to movement of a clot plugging the aqueduct

A rare case of transient hydrocephalus is reported. A 64-year-old woman presented with headache. Computerized tomography (CT) scan revealed hydrocephalus with tiny blood clots in the left foramen of Monro and in the aqueduct. Six hours after the onset, the signs and symptoms disappeared spontaneously. The second CT showed improvement of the hydrocephalus with migration of the clot into the i.v. ventricle. Aqueductal trapping and releasing of the clot formed by bleeding from the choroid plexus located in the left foramen of Monro was suspected for the origin of the transient hydrocephalus.

Coronal MR imaging for visualization of wallerian degeneration of the pyramidal tract.

A coronal image taken along a straight line between the front edge of the medulla and the deepest point of the interpeduncular cistern clearly displayed wallerian degeneration of the segment of the pyramidal tract between the internal capsule and the pons, the medulla, or the decussation. This visualization was verified in 21 patients with moderate or severe hemiparesis following a stroke episode.

Pineal and suprasellar metastasis of lung cancer : Case report and review of the literature

A very rare case of simultaneous pineal and suprasellar metastasis of lung cancer in a 46-year-old man is reported. Simultaneous mass lesions in these regions are usually diagnosed as primary germ cell tumors in the central nervous system. The clinical features and differential diagnosis are discussed.

Nonconvulsive status epilepticus following implantation of subdural grid electrodes in a brain tumor patient.

Implantation of subdural electrodes is considered to be safe and conventionally performed during epilepsy surgery. The application has been recently expanded into brain tumor surgery for the presurgical evaluation of the cerebral function, wherein no major complications have been reported (Kral et al., 2007; Little et al., 2008; Wellmer et al., 2012). We herein present a precautionary case in a patient with a high-grade glioma who showed transient neurological deficits after the implantation of subdural grid electrodes. A 69-year-old woman was admitted to our hospital with a complaint of mild speech and gait disturbance. Baseline laboratory investigations were normal. Contrast-enhanced magnetic resonance imaging (MRI) revealed a ring-enhanced tumor mass in the white matter under the speech and primary motor areas, which was associated with extensive vasogenic edema (Fig. 1A and B). Since malignancy was suspected, we elected to resect not only the tumor mass but the peripheral tissue. Due to the location of the tumor, functional cortical mapping was planned. Scalp electroencephalography showed infrequent spikes over the left parietal area, and Fostoin (750 mg/day for the first day followed by 375 mg/day) was preoperatively administered for seizure prevention. Craniotomy was performed with the aid of an intraoperative navigation system. Following the incision of the dura, mild brain swelling was observed. The primary motor area was identified using somatosensory and motor evoked potentials. A sheet of 5 6 channel subdural grid electrodes (measuring 39 47 mm in size) with a thickness of 0.8 mm (Unique Medical Co., Japan) was slipped into the subdural space to cover the cortical region of interest (Fig. 1C). No particular intraoperative complications were recognized. The follow-up head CT scan on the next morning was unremarkable. Spinal fluid leakage was not evident and the baseline laboratory investigations were normal. On that evening, however, the patient became slightly lethargic with worsened motor aphasia and right hemiparesis. An emergent head CT scan did not show any additional intracranial lesions (Fig. 1D). While no convulsive seizures were apparent, electrocorticography (ECoG) recorded from the subdural electrodes on the same day showed continuous slow waves, which were composed of triphasic and